Question

Which of the following anticancer drugs produces hand-foot syndrome?

• A. Methotrexate
• B. Capecitabine
• C. Vincristine
• D. Doxorubicin

Hint:

Hand-foot syndrome is a distinctive dermatological toxicity of capecitabine and some other fluoropyrimidines; early recognition helps in effective management and dose modification.

Answer 1

The Correct Option is B

Hand-foot syndrome, also known as palmar-plantar erythrodysesthesia, is a common adverse effect associated with certain chemotherapeutic agents. It is characterized by redness, swelling, pain, and peeling of the skin on the palms of the hands and soles of the feet. - Capecitabine is an oral prodrug of 5-fluorouracil (5-FU) widely used in cancer chemotherapy. It is well known to cause hand-foot syndrome as a dose-limiting toxicity. The syndrome results from the drug’s effect on rapidly dividing skin cells and capillary damage in the extremities. - Other drugs listed, such as Methotrexate, Vincristine, and Doxorubicin, have different toxicity profiles but are not commonly associated with hand-foot syndrome. Management of hand-foot syndrome includes dose adjustment, symptomatic treatment with emollients, and sometimes corticosteroids.

Answer 2

Hand-foot syndrome, or palmar-plantar erythrodysesthesia, shows up as redness, tenderness, and peeling on the palms and soles. It is tied to specific chemotherapy drugs that concentrate in small capillaries in the extremities, so checking each drug's known toxicity profile identifies the culprit.

1. Methotrexate: Methotrexate is a folate antagonist whose classic toxicities are bone marrow suppression, mucositis, and liver damage. Hand-foot syndrome is not a typical side effect linked to this drug.
2. Capecitabine: Capecitabine is broken down into 5-fluorouracil once inside the body, and this active metabolite builds up in the eccrine sweat glands of the palms and soles. The resulting local toxicity to skin and capillaries in these areas is what produces hand-foot syndrome, making it a well recognized, dose-limiting side effect of this drug.
3. Vincristine: Vincristine is a vinca alkaloid best known for causing peripheral neuropathy and constipation from its effect on nerve microtubules, not skin toxicity on the hands and feet.
4. Doxorubicin: Doxorubicin is notable for cardiotoxicity and tissue damage if it leaks outside a vein during infusion. While a liposomal form of doxorubicin can occasionally cause hand-foot type skin changes, the conventional drug listed here is best known for cardiac and infusion-site effects, not this syndrome.

Among the four, only capecitabine's metabolism and skin distribution pattern explain the localized damage seen in hand-foot syndrome.

So the correct answer is Capecitabine.